Can the UK achieve world class outcomes in cancer treatment?

Late last year, the Department of Health announced a new pilot scheme to find out if computer programmes could help GPs to estimate a patient’s risk of cancer.

This is one of a number of measures that the Government, and organisations like us, are introducing as part of a drive to detect cancers at an earlier stage, when they are more likely to be treated successfully.

Professor Mike Richards, the National Cancer Director unveiled the move in an interview with the Guardian. The new computer software will consider factors like age, weight and symptoms, to work out if people are likely to have cancer and whether they should be referred to a specialist.

A typical GP only sees about 8 or 9 cases of cancer in a year – and most of these will be the most common types of the disease. Cancer shares many of its symptoms with other, less threatening illnesses and this can mean GPs have a difficult job spotting the many types of cancer at an early stage.

Speaking about the computer-assisted risk assessments, Professor Richards said, “GPs will welcome this because it will make their diagnoses quicker and better. Over time this will save lives.” But he emphasised, “The GP will always have the final say. If he wants to refer a patient to hospital, he will always have the right to do so.”

How do we compare?

Professor Richards superbly summed up why early diagnosis is important in a recent talk at the Royal College of Physicians in London. He noted that large studies have shown that the UK has poorer cancer survival rates compared to the best performing countries in Europe. Late diagnosis – where people’s cancer is at quite an advanced stage before they receive treatment – is thought to play a large role in this.

So what does the UK need to do to achieve world-class outcomes in cancer treatment?

First, Professor Richards defined ‘world-class’ as when ‘the overall burden of cancer in England would be as low as anywhere in the developed world’. So, essentially he wants to see the lowest number of people developing cancer in the first place, and the lowest number of people subsequently dying from the disease. And we need a high quality of care for people with cancer and good health and wellbeing for the growing number of people who survive the disease.

The latest figures for England, compared to the rest of Europe, show the proportion of men developing cancer is better than average and the numbers of men dying from cancer are average. But the proportion of women developing cancer – and dying from cancer – are worse than average.

So there is plenty of room for improvement – particularly among older people, where the number of people dying from cancer isn’t falling over time, in line with other western countries.

Richards quoted Professor Michel Coleman, who has estimated that “around 10,000 deaths within five years of a cancer diagnosis could have been avoided each year in Britain in the late 1990s if survival matched the best in Europe”.

In Richards’ opinion, “10,000 avoidable deaths per year is frankly unacceptable”.

What is the situation in the UK?

Richards pointed out that there are areas where the UK is doing well. Death rates from cancer have fallen by nearly 20 per cent since 1995, particularly among men under the age of 65.

Accordingly, this “reflects where we are with lung cancer epidemics”, where the number of male smokers has dropped dramatically over recent years. In fact, just 21 per cent of people in the UK still smoke (although this figure is as low as 14-15 per cent in other countries).

Death rates from cancer have also fallen among women, but to a lesser extent – this is consistent with the fact that the number of female smokers hasn’t yet fallen in the same way as the number of male smokers.

Our screening programmes are also “among the best in the world” due to our effective processes to invite people for screening. And UK waiting times have improved markedly over recent years.

But the proportion of people receiving curative and palliative treatments is still low compared to some other countries, Richards said. Addressing these areas could make a big difference in the future.

For example, the best way to treat a type of lung cancer called ‘non-small-cell’ lung cancer is to cut it out. While this isn’t always an option for advanced tumours, surgery is only used in around 10 per cent of cases in the UK, compared to 20 per cent in other countries.

We also use fewer anti-cancer drugs, around two-thirds of the level used in other countries, according to 2007’s Cancer Reform Strategy. But many of these drugs are used for palliative care and do not play a large role in increasing survival. A detailed study of drug use is underway to get comprehensive information on how we compare to other countries in terms of our drug use.

So why are we below the best?

Professor Richards believes it is a combination of factors.

For example, health service provision in the UK could be improved. Unhealthy lifestyles could also play a role, although this mainly affects the number of people who develop cancer rather than survival rates. Our investment in cancer services could also be improved, although it’s not clear what impact this will have.

Last year, the UK spent approximately 5 per cent of the NHS budget on cancer, well below the levels of other European countries, notably France (7 per cent) and Germany (9 per cent).

For the moment, it’s not clear why we are still lagging behind other parts of Europe, because there isn’t a lot of detailed data quantifying and comparing the contribution of different things.

Thankfully, these data are currently being gathered. However, Professor Richards said ‘A great deal of indirect evidence points to late diagnosis and low curative intervention rates as the major factor underlying poor survival in the UK’

What do we need to do about it?

Thankfully, as we’ve mentioned several times recently, there’s a renewed focus on early detection and symptom awareness. The NAEDI initiative, launched over a year ago, is now in full swing, and hard evidence is being collected and disseminated (there’s more information about NAEDI on our main website).

And finally…

Professor Richards said that if he could “wave a magic wand”, the most important change he would make is to emphasise the importance of prevention and early diagnosis. A lot has been done to improve the care that people receive after they are referred on to specialists but we can do a lot more to get people referred and diagnosed earlier to “bring survival rates up”.

New initiatives like NAEDI in England, and the cancer-risk assessment software, are positive steps to help tackle to problem, prevent avoidable deaths and put the UK on par with the rest of Europe. We would welcome a similar focus on early diagnosis in other areas of the UK.

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